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  5. Bushman Psychological Services, LLC

Bushman Psychological Services, LLC

Company Details

Name: Bushman Psychological Services, LLC
Jurisdiction: Minnesota
Legal type: Limited Liability Company (Domestic)
Status: Active / In Good Standing
Date formed: 19 Aug 2003 (21 years ago)
Company Number: fe2840d3-86d4-e011-a886-001ec94ffe7f
File Number: 596713-2
Registered Office Address: 14551 Judical Rd #100, Burnsville, MN 55306, USA
Principal Executive Office Address: 14551 Judicial Road Ste 100, Burnsville, MN 55306, USA
ZIP code: 55306
County: Dakota County
Place of Formation: Minnesota

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BUSHMAN PSYCHOLOGICAL SERVICES, LLC PENSION PLAN 2014 680565248 2015-05-11 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2015-05-10
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-10
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC 401(K) PLAN 2014 680565248 2015-05-11 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-10-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2015-05-10
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-10
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC PENSION PLAN 2013 680565248 2014-10-03 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2014-10-03
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-03
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC 401(K) PLAN 2013 680565248 2014-10-03 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-10-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2014-10-03
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-03
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC PENSION PLAN 2012 680565248 2013-06-03 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 5
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2013-06-02
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-02
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC 401(K) PLAN 2012 680565248 2013-06-03 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-10-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2013-06-02
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-02
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC PENSION PLAN 2012 680565248 2013-06-07 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Signature of
Role Plan administrator
Date 2013-06-07
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-06-07
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC PENSION PLAN 2011 680565248 2012-06-20 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 4
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2005-01-01
Business code 621330
Sponsor’s telephone number 6516869080
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Plan administrator’s name and address
Administrator’s EIN 680565248
Plan administrator’s name BUSHMAN PSYCHOLOGICAL SERVICES, LLC
Plan administrator’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372
Administrator’s telephone number 6516869080

Signature of
Role Plan administrator
Date 2012-06-20
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-20
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC 401(K) PLAN 2011 680565248 2012-06-19 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-10-01
Business code 621330
Sponsor’s telephone number 6516869080
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Plan administrator’s name and address
Administrator’s EIN 680565248
Plan administrator’s name BUSHMAN PSYCHOLOGICAL SERVICES, LLC
Plan administrator’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372
Administrator’s telephone number 6516869080

Signature of
Role Plan administrator
Date 2012-06-19
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-06-19
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
BUSHMAN PSYCHOLOGICAL SERVICES, LLC 401(K) PLAN 2010 680565248 2011-09-27 BUSHMAN PSYCHOLOGICAL SERVICES, LLC 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-10-01
Business code 621330
Sponsor’s telephone number 6127515043
Plan sponsor’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372

Plan administrator’s name and address
Administrator’s EIN 680565248
Plan administrator’s name BUSHMAN PSYCHOLOGICAL SERVICES, LLC
Plan administrator’s address 8935 LEGEND CLUB DRIVE, PRIOR LAKE, MN, 55372
Administrator’s telephone number 6127515043

Signature of
Role Plan administrator
Date 2011-09-27
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-09-27
Name of individual signing GREGORY DEWEESE
Valid signature Filed with authorized/valid electronic signature

Manager

Name Role Address
Kimberly DeWeese Manager 14551 Judicial Road Ste 100, Burnsville, MN 55306, USA

Agent

Name Role
Gregory DeWeese Agent

Filing

Filing Name Filing date
Amendment - Limited Liability Company (Domestic)Election to 322C Election to Become a Professional Firm Professional Service - Psychology Restated Articles 2017-01-19
Registered Office and/or Agent - Limited Liability Company (Domestic) 2011-05-02
Annual Reinstatement - Limited Liability Company (Domestic) 2006-11-09
Administrative Termination - Limited Liability Company (Domestic) 2006-01-11
Original Filing - Limited Liability Company (Domestic) 2003-08-19
Limited Liability Company (Domestic) Business Name (Business Name: Bushman Psychological Services, LLC) 2003-08-19

Related by officers

Gregory DeWeese

KG Properties L. L. C.

Related by address

No related companies by address

Date of last update: 26 Sep 2024

Sources: Minnesota's Official State Website

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